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Bill

A 443

Relates to step therapy protocol

2025 Regular Session Introduced by John McDonald and 1 co-sponsor

Bill A 443 ensures timely access to medications by regulating step therapy protocols, protecting patients from delays and requiring insurers to be transparent and fair.

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Bill Summary · A 443

Summary of Bill A 443: Step Therapy Protocol

Bill Number: A 443
Title: Relates to Step Therapy Protocol
Status: Signed into Law (Chapter 20)
Introduced: January 08, 2025
Classification: Legislative Bill

Purpose and Intent

Bill A 443 aims to regulate the use of step therapy protocols in healthcare. Step therapy, also known as "fail first," is a cost-control strategy used by health insurers that requires patients to try less expensive treatments before moving on to more expensive ones. The intent of this legislation is to ensure that patients have timely access to necessary medications and treatments, while also providing a framework for transparency and fairness in the application of step therapy.

Key Provisions

  • Patient Protections: The bill establishes clear guidelines that insurers must follow when implementing step therapy protocols. This includes:

    • Clinical Review: Insurers must conduct a clinical review to determine the appropriateness of the step therapy protocol for each patient.
    • Exemptions: Certain patients may be exempt from step therapy requirements, particularly those with specific medical conditions or previous treatment failures.
    • Timely Decisions: Insurers are required to make timely decisions regarding step therapy requests to avoid delays in patient care.

  • Transparency Requirements: The bill mandates that insurers provide clear information to patients and healthcare providers about the step therapy process, including:

    • Criteria for step therapy protocols.
    • The appeals process for patients who wish to contest a step therapy decision.

  • Reporting Obligations: Insurers must report data on the use of step therapy protocols, including the number of appeals and outcomes, to ensure accountability and monitor the impact of these protocols on patient care.

Affected Parties

  • Patients: Individuals who require medications that may be subject to step therapy protocols will benefit from the protections and transparency established by this bill.
  • Healthcare Providers: Doctors and healthcare professionals will have clearer guidelines and support when advocating for their patients' needs against step therapy requirements.
  • Insurance Companies: Insurers will need to adjust their policies and procedures to comply with the new regulations set forth in the bill.

Procedural Timeline

  • January 08, 2025: Bill A 443 is introduced and referred to the Insurance Committee.
  • January 28, 2025: The bill is reported and ordered to third reading.
  • February 04, 2025: The bill passes the Assembly and is delivered to the Senate.
  • February 11, 2025: The Senate passes the bill, which is then returned to the Assembly.
  • February 12, 2025: The bill is delivered to the Governor.
  • February 14, 2025: Bill A 443 is signed into law, becoming Chapter 20.

Related Legislation

  • S 2676: This bill serves as a companion to A 443, addressing similar issues related to step therapy protocols.

In summary, Bill A 443 establishes important regulations surrounding step therapy protocols, aiming to protect patients' access to necessary treatments while ensuring that insurers operate transparently and fairly.

Compiled from official sources — confirm details with the bill’s official record.

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